Management of Tracheal Surgery Complications

Leschber, Gunda

doi:10.1016/j.thorsurg.2013.09.002

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…An anesthesia machine was used as a mechanical ventilator to maintain the blood oxygen saturation (SpO2) above 95%. Any temporal decline in blood oxygen saturation (SpO2 < 95%) was recorded when keeping oxygen saturation above 95% during the surgical process, as indicated in previous studies 16,17 …”

Section: Methodsmentioning

confidence: 67%

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Intraoperative airway management for patients with tracheal tumors: A case series of 37 patients

Gao

Zhang

et al. 2021

Thoracic Cancer

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Background Tracheal tumors are rare. The aim of this case series was to investigate airway selection during radical surgery for patients with tracheal tumors. Methods Here, we performed a retrospective case review of patients with tracheal tumors who underwent tracheal surgery in our center. A total of 37 cases, including 26 patients with primary tracheal tumors and 11 cases with advanced thyroid cancer, were enrolled into the study. Baseline characteristics and differential prognosis of included patients were estimated. We summarize the strategies for intraoperative airway selection and analyze the risk factors associated with delayed extubation. Results There is a trend for primary tracheal tumors to appear toward the upper (9 of 26) and middle third (9 of 26) of the trachea, followed by the lower third airway (8 of 26). Advanced thyroid cancers occur most frequently in the upper trachea (7 of 11) and then the middle trachea (4 of 11). All primary and secondary patients underwent R0 resection. Minor histological subtypes were found to correlate with a poor prognosis. Extracorporeal support and tracheotomy intubation were applied in high‐risk cases, and a total of 32 patients achieved intrathoracic intubation during the surgical process. Intensive care unit (ICU) delay (>1 day) was observed among 25 patients, which were not enriched in cases who underwent cross‐field endotracheal intubation. Additionally, temporal suboptimal oxygenation (SpO2 < 95%) was an independent risk factor of ICU delay. Conclusions Airway selection plays an important role in successful tracheal surgery, and an appropriate ventilation routine depends on the patient and a surgical process which is safe and effective.

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Section: Methodsmentioning

confidence: 67%

“…Any temporal decline in blood oxygen saturation (SpO2 < 95%) was recorded when keeping oxygen saturation above 95% during the surgical process, as indicated in previous studies. 16 , 17 …”

Section: Methodsmentioning

confidence: 99%

Intraoperative airway management for patients with tracheal tumors: A case series of 37 patients

Gao

Zhang

et al. 2021

Thoracic Cancer

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“…Tracheostomies are commonly performed surgical procedures, with TIF being a rare but serious complication that can arise due to idiosyncratic patient characteristics, surgical indication, and the procedural variables of the surgical technique. [1][2][3][4][5]7,[9][10][11][12][13] Due to the low clinical incidence of this condition and its high mortality rate, robust evidence regarding optimal treatment approaches is lacking. 2,3,7,12,15 Given the breadth of indications for tracheostomy procedures and the variety of providers performing the procedure, there was variability in setting, technique, postoperative care, and data variables reported.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,7,8 The incidence of TIF after tracheostomy is low, ranging from .1 to 1.0%. 2,3,7,[9][10][11][12][13] Specific risk factors for TIF include a low tracheal incision during the tracheostomy, excessive initial tracheostomy cuff inflation, excessive cannula depth within the trachea, a high riding innominate artery, congenital anomalies, structural malformations, and tracheostomy site infection. [2][3][4]7,14 The pathophysiologic mechanism behind TIF formation is pressure-induced mucosal ischemia leading to erosion into the posterior wall of the innominate artery.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of Mortality Associations in Patients who Develop Tracheoinnominate Artery Fistula Following Tracheostomy

Ward,

Hinchman-Dominguez,

Stokes

et al. 2024

The American Surgeon™

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Objective Tracheoinnominate artery fistulas (TIFs) are a rare but deadly complication of tracheostomy. Tracheoinnominate artery fistula cases in the literature were summarized in order to understand mortality associations. Methods MEDLINE was searched for studies reporting individual characteristics of patients with TIFs after tracheostomy, excluding cases without tracheostomy or with additional procedures at the tracheostomy site. This study followed PRISMA guidelines. Results 121 TIF patients from 18 case series and 46 case reports were included. The median age was 40 years, and 52.9% were male. The overall mortality rate was 64.5%. There were differences in mortality between cases that presented initially with vs without sentinel bleeding (odds ratio [OR] .34; CI [confidence interval] .16-.73; P = .006). The mortality rate also differed in whether or not the tracheostomy cuff was over-inflated for temporary hemostasis during resuscitation (OR 3.57 (CI 1.57-8.09); P = .002). Treatment compared to no treatment had lower mortality rates (OR .11 (CI 0.04-.32); P < .001); no differences were found if treatment was endovascular vs open surgical. Conclusions Mortality is a major concern after detection of a TIF and resuscitation paired with endovascular or open surgical intervention is imperative. Rapidly investigating sentinel bleeds and intervening upon hemorrhage with temporary cuff over inflation may lead to improved outcomes.

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“…The most important cause of traction pressure is the length of the resected trachea. Various factors including the length of resected trachea, previously existing tracheal device, tracheal resection and medical comorbidities such as diabetes and obesity have been shown to increase the risk for anastomotic complications (12,13).…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Benign Tracheal Stenosis: Analysis of Twenty-One Patients

2019

GMJ

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Objective: The objective of this study was to retrospectively evaluate 21 cases of tracheal stenosis that underwent surgery due to benign tracheal stenosis. Methods: A total of 21 patients who underwent surgery due to benign tracheal stenosis in our clinic between 2010 and 2017 were retrospectively evaluated. The patients were analyzed in terms of age, gender, surgical indication, surgical approach, comorbidities, length of the trachea resected, postoperative complications, the duration of hospitalization and development of restenosis. Results: Out of 21 patients, 12 were male and nine female. Surgical indication was postintubation tracheal stenosis in 15 patients. The mean age was 39.6 (10-83) and the mean length of resection was 3.33 cm. Collar incision was performed in 16, collar and sternotomy incision in 3, and sternotomy incision in 2 patients. Complication rates were high in patients with comorbidity. Conclusion: Tracheal surgery is mostly applied due to benign disease in addition to the malignant diseases of the tracheal surgery is mostly performed with low rates of morbidity and mortality, and the outcomes are usually satisfactory.

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Management of Tracheal Surgery Complications

Cited by 7 publications

References 11 publications

Intraoperative airway management for patients with tracheal tumors: A case series of 37 patients

Intraoperative airway management for patients with tracheal tumors: A case series of 37 patients

A Systematic Review of Mortality Associations in Patients who Develop Tracheoinnominate Artery Fistula Following Tracheostomy

Surgical Treatment of Benign Tracheal Stenosis: Analysis of Twenty-One Patients

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